Nerve blocks on forelimbs and hindlimbs as part of a multimodal analgesia plan

Multimodal analgesia should be incorporated into any surgical procedure; this article will discuss the use of thoracic limb and pelvic limb locoregional blocks as part of a multimodal analgesic approach to pain management in the canine and feline surgical patient.

Locoregional blocks use local anaesthetic agents to attempt to totally block transmission of any pain sensation from the neurons stimulated during nociception. Local anaesthetics work on blocking any impulse in myelinated and unmyelinated nerve fibres by inhibiting voltage-gated sodium channels, and are therefore the most effective way to prevent sensation of the central nervous system.

According to randomised controlled studies in humans, using locoregional anaesthesia in conjunction with a general anaesthetic, helps decrease postoperative recovery times, reduce the length of hospital stays, and provides superior pain relief in patients when compared with the use of systemic opioids (Singelyn et al, 1998; Capdevila et al, 1999). Campoy (2008) mentioned that the key features of regional anaesthesia combined with less invasive surgical techniques can encourage early appetite and increased mobility, decreasing severity of complications, and hence decreasing the length of hospital stays, overall making the patient more comfortable. Therefore, locoregional anaesthesia techniques should be considered in the anaesthetic planning for veterinary patients undergoing surgery.